Childhood vaccination usually consists of the typical measles, mumps, rubella, tetanus, influenza and the list goes on. A story that has
reached national news recently is the controversy about testing anthrax
vaccination in children. When I came across this article on the NBC News
webpage, I honestly never even knew people got vaccinated for anthrax exposure.
Caplan (2013), the head of the Division of Medical Ethics at NYU, talks about
the controversy of this topic and why it is risky to approve studying the
safety of anthrax vaccines in children. The reason that one may be interested
in vaccinating their child in the first place is in sight of a terror attack.
The U.S. government conducted a bioterrorism preparedness exercise in 2011
studying the results of anthrax spores on a major city. Results
demonstrated that “nearly 8 million citizens would be affected, nearly a
quarter of them children” (Caplan, 2013). The National Biodefense Science Board
and other commissioners are recommending that the government start conducting
studies in pediatric patients but Caplan revokes, “there is not a chance that a
sufficient number of American parents are going to sign up their kids” (2013).
Anthrax vaccines are given to millions of adults in the military, however no one
knows what effect using this vaccine would cause in children (Caplan, 2013).
Also, if a child has any other medical diagnoses such as allergies, asthma,
diabetes, or cancer, the risk for testing increases greatly.
This controversy about testing in children or not leads to a great mess of
ethical and legal issues. According to Caplan’s article, “the commissioners
have found a small ethical opening through which a study might pass” (2013). To
me, this type of research has ethical issues written all over it. First of all,
parents would need to voluntarily sign up to be part of this study. As
mentioned above, I’m not so sure how many parents would be willing to jump on
this band wagon. The vaccine itself is a series of five- yes I said five-shots
(Caplan, 2013). Military participants find this vaccination helpful and the
side effects of burning, headaches, joint and muscle aches, and rashes are
nothing compared to being bombarded with an anthrax-loaded shell. In children,
however, these simple side effects can be exacerbated by any other medical
diagnoses or their physical immaturity in general. From a community health
standpoint, I can see why commissioners would want to study this in children.
If a community were to experience a bioterrorism attack, a disaster plan could
be implemented and the population may see less complications if anthrax
vaccines were offered to all ages. Overall, I do not see studying the safety of
anthrax in a pediatric population as ethical. Parents may inquire about this
vaccine for their children, and it is our duty to understand and give the best
recommendation for the health of their child. According to Hockenberry and
Wilson (2011), “ nurses are at the forefront in providing parents with
appropriate information regarding childhood immunization benefits,
contraindications, and side effects on the child’s health” (p. 506). The
parents that would volunteer children may only do so because they have a
healthy child. The study population may be skewed and could affect results. Overall,
there are too many unknowns and preventable harm could be caused to young,
innocent children.
References
Caplan,
A. (2013, March 19). Bioethicist: No chance of anthrax trials in kids. NBC News. Retrieved from http://vitals.nbcnews.com/_news/2013/03/18/17361790-bioethicist-no-chance-of-anthrax-vaccine-trials-in-kids?lite
Hockenberry,
M. J., & Wilson, D. (2011). Wong's nursing care of infants and children. St. Louis, MO: Mosby/Elsevier.
I have to agree that the likelihood of approving the study of anthrax vaccination for children is going to have its hiccups. However, I do find that it is an important segment for research. Anthrax has long been an issue concerning bioterrorism and the threat to U.S citizens. The last suspected bioterrorist act occurred in 2001 when 5 of 22 confirmed cases of people died from anthrax inhalation(). Due to the infectious nature of inhalation anthrax, a large release of the spores could cause a severe outbreak resulting in death to many who are exposed. As dangerous as anthrax is in a terrorist situation, it is an otherwise controlled disease through vaccinations among animals carrying the infection. That is why I believe parents will not weigh this one severity with another that would hit closer to home: the unknown effects of allowing their children to receive an anthrax vaccination. Unless an anthrax outbreak had a wider impact that hit closer to home, I do not believe these studies will go beyond the lab of animal testing. Long-term effects are still unknown among adults who have been vaccinated.
ReplyDeleteIn the perspective of a nurse who may come across the ethical issues and relating this information to the public when they ask what is being done or what are the risks, it is important to always keep the parents informed in an unbiased way. The truth is that we may someday find that vaccines should have been tested and studied more extensively before the need for them arose, but not many are convinced that the need for them is now. I am comforted that research continues for the safety of the population and that if the need became dire, there is at least something for people to turn toward for the safety of our children.
Wright J.G., Quinn C.P., Shadomy S., Messonnier N. (2010, July 23). Use of anthrax vaccine in the united
states. Centers for disease Control and Prevention. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5906a1.htm?s_cid=rr5906a1_e
Amber!-Very interesting article! As we advance in science and technology there is one thought that pops into my mind: just because we can, doesn’t mean we should…Although we may be getting close to finding preventive vaccine for anthrax in case for a biomedical terrorist attack, does not certainly mean I would sign my child up to get it!!! There is way too much unknowns left with this vaccine that make it understandable why officials are halting further testing. I also feel that we don’t have that much a threat that this would be necessary. I found it quite comical that at the end of the article how parents should maybe consider more relevant problems in their children lives like nutrition or bullying (Caplan, 2013). How fascinating to see that of those vaccinated, 30% -60% "experienced a wide range of side effects such as “soreness, redness, itching, swelling and or lumps at the injection site, plus ailments like rashes, headaches and joint and muscle aches” (Caplan, 2013). I feel this statistic is way too high with way to many possibilities.
ReplyDeleteAs nurses we have to always think about what is ethical and unethical behavior. I feel for me as an RN I would not be comfortable advocating for this vaccines advancement in testing, let alone recommend giving it to my patients. Like you had mentioned, an RN’s most critical job is client education. Advocating for immunizations and vaccines is important information for new parents, but that also means informing them of the truths-- whether that is good or bad news!!
Caplan, A. (2013, March 19). Bioethicist: No chance of anthrax trials in kids. NBC News. Retrieved from http://vitals.nbcnews.com/_news/2013/03/18/17361790-bioethicist-no-chance-of-anthrax-vaccine-trials-in-kids?lite
I thought that this article was very interesting, thank you for bringing it to our attention. My first thought was if I were a parent I would NOT subject my child to testing for anthrax vaccinations. The general public has a fright at just the mention of the word “anthrax” and I do not imagine that most parents would volunteer their children for this. The article even states that this type of experiment has no chance of happening and I must agree (Caplan, 2013).
ReplyDeleteAlthough testing the vaccine in children would allow us to be more prepared in case of an actual bioterrorism attack, it is not likely that parents will allow it. Wanting to know the effects of the vaccine before it is needed is an example of up-stream thinking and it is a productive idea. Problems occur when we look at the ethical and moral issues of the situation. Current studies display vague risks and it is obvious that not enough information has been collected in order to deem the vaccine “safe”. The vaccination is also a series of five shots, which may lead to compliance issues among participants (Caplan, 2013). Parents may be more willing to have their children tested if the threat of bioterrorism were greater. Hopefully we will not have to see a day when this is the truth.
As nurses it is our job to advocate for and educate our patients. We must first educate ourselves and be fully aware of all the consequences and benefits that vaccinations provide. Only once we are confident in our own knowledge are we able to teach our patients what is best practice. It is our responsibility to have the most current and correct information regarding vaccinations. We must also account for ethical and moral issues, which play a big role in this specific situation. After we are educated, it is our job to inform parents and assist them in making the best decision for their specific situation.
References
Caplan, A. (2013, March 19). Bioethicist: No chance of anthrax trials in kids. NBC News. Retrieved from http://vitals.nbcnews.com/_news/2013/03/18/17361790-bioethicist-no-chance-of-anthraxvaccine-
trials-in-kids?lite
This is a very interesting article! I have not heard of this happening. I can’t see it moving forward though. Due to the complications you stated and the unknown of how it will affect children I don’t see parents lining up to sign their children up. In theory I think it is a very good idea and would make us more prepared for a potential bioterrorist attack, I don’t see the research on children going anywhere at this time. Right now I think it is important to keep researching it further and maybe in the future it will be a routine vaccination. This is a hard topic to research though because when you involve children in the research it is an ethical dilemma.
ReplyDeleteAnthrax is a very serious disease and can be fatal, but how likely is it that people are exposed? When weighing the benefits and risks, is there a big difference? I think this is a very controversial topic and when it deals with ethics and children, it gets even more controversial. I think from the nursing standpoint we just have to be very unbiased when answering questions from concerned parents. We can educate and help them weight the risks and benefits, but it is ultimately the parents decision and we have to respect that.
Amber – I think you did a great job bringing the information of anthrax vaccination forward. Myself, like the others, had no idea that the vaccination even existed and honestly I haven’t thought of anthrax much since the big scare when I was in junior high. Ethically there is a big debate on whether giving the vaccination to children is safe and if the benefits outweigh the risks. So what are the risks? As Karla questioned, how prevalent is anthrax?
ReplyDeleteThe Center for Disease Control (CDC), states that “in the average year, the change that any one individual in the United States will contract anthrax is extremely low – about one case in nearly 300 million” (2003). The CDC additionally states that “in 2001, even with the intentional release of Bacillus athracis spores in some environments, the nationwide risk was still extremely low – about 23 cases in nearly 300 million people” (2003).
So let’s pretend that you vaccinate your family and you encounter anthrax. Will it benefit you? According to the National Network for Immunization Information (2005), a controlled study of mill workers in 1962 found that “the anthrax vaccine was 92.5% effective at protecting against [both cutaneous and inhalational cases of] anthrax”.
All in all, we are unable to predict the future and whether bioterrorism will affect any of us. I would like to think that we live in a peaceful world where violent acts of terror don’t exist. However, that isn’t the case and some parents will do everything they possibly can to protect their children. It is the job of the health care providers, such as nurses, to educate parents on the benefits and risks of the vaccination.
References
Center for Disease Control and Prevention. (2003, May 2). CDC Anthrax Q&A: Risk. Retrieved from http://www.bt.cdc.gov/agent/anthrax/faq/risk.asp
National Network for Immunization Information. (2005, March 11). Anthrax. Retrieved from http://www.immunizationinfo.org/vaccines/anthrax
According to Neil Miller, author of the Vaccine Safety Manual, the average American child receives a whopping 26 vaccinations in their lifetime (Miller, 2012). I think it is important to remember that vaccinations can have long and short term side effects just like any drug and benefits need to outweigh the potential negative effects for a vaccine to be useful. It is understandable for a soldier heading to a warzone to be required to have the anthrax vaccination because there is a real possibility that they could be exposed to this bacteria being used as a biological weapon. Let’s ask ourselves the possibility that a mass number of our children will be exposed to anthrax, probably not very likely.
ReplyDeletePersonally I do not feel the benefits will outweigh the potential side effects of adding yet another vaccination to the regimen and the trauma of receiving FIVE injections and this is before the clear ethical issues are even involved. If I were a parent this is not a study I would want my child to participate and I feel that most other American parents will feel similarly. Time and money may be better spent trying to prevent death from motor vehicle injuries, the leading cause of death in children over 1 year old (Nies & McEwen, 2011).
Miller, N.Z. (2012). Vaccine safety manual for concerned families and health practitioners. Santa Fe, NM: New Atlantean Press.
Nies, M.A., McEwen, M. (2011). Community/public health nursing: Promoting the health of populations. St. Louis, MO: Elsevier.
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